From the Guidelines
Levomepromazine can cause a significant drop in blood pressure, particularly when changing from a lying down to a sitting or standing position, due to its potential to induce orthostatic hypotension 1.
Key Points
- The medication is an antipsychotic phenothiazine with a rapid onset of action, used in cases of delirium, and has some analgesic effect 1.
- Adverse effects of Levomepromazine include orthostatic hypotension, paradoxical agitation, extrapyramidal symptoms, and anticholinergic effects 1.
- The starting dose of Levomepromazine can be as low as 12.5–25 mg, with a continual infusion of 50–75 mg, and the usual effective dose ranges from 12.5 or 25 mg every 8 hours to up to 300 mg/day continual infusion 1.
- It is essential to monitor patients for signs of orthostatic hypotension, especially when initiating or adjusting the dose of Levomepromazine, to minimize the risk of falls and other complications associated with blood pressure drops 1.
Considerations
- The risk of orthostatic hypotension with Levomepromazine is a consideration in its use, particularly in patients who are already at risk for falls or have cardiovascular conditions 1.
- Given the potential for orthostatic hypotension, it is crucial to carefully assess the benefits and risks of using Levomepromazine in clinical practice, especially in vulnerable populations such as the elderly or those with pre-existing hypotension 1.
From the Research
Orthostatic Blood Pressure and Levomepromazine
- There is limited information available on the effect of Levomepromazine on orthostatic blood pressure.
- One study 2 mentions that levomepromazine caused more hypotension compared with risperidone, which may be relevant to orthostatic blood pressure.
- However, this study does not specifically examine the effect of levomepromazine on orthostatic blood pressure.
- Another study 3 does not mention orthostatic blood pressure or any related effects.
- The remaining studies 4, 5, 6 do not provide any information on the effect of levomepromazine on orthostatic blood pressure.
Related Effects
- Dizziness was common with levomepromazine compared with other antipsychotic medications 2.
- Levomepromazine caused less tremor and less antiparkinsonian medication administration compared with haloperidol 2.
- However, these effects may not be directly related to orthostatic blood pressure.
Available Data
- The available data does not enable us to confidently comment on the effectiveness of levomepromazine for schizophrenia, let alone its effect on orthostatic blood pressure 2.